1/17. The spectrum of dilated cardiomyopathy. The Johns Hopkins experience with 1,278 patients.This report describes the evaluation of 1,278 patients referred to The Johns Hopkins Hospital with dilated cardiomyopathy. After a careful history and physical examination, selected laboratory tests, and endomyocardial biopsy, a specific diagnosis was made in 49% of cases. In 16% of cases the biopsy demonstrated a specific histologic diagnosis. myocarditis and coronary artery disease were the most frequent specific diagnoses; 51% of patients were classified as idiopathic. Thus a rigorous and systematic search can demonstrate an underlying cause for approximately one-half of patients with unexplained cardiomyopathy. Endomyocardial biopsy plays a crucial role in this evaluation. Six cases are presented which demonstrate the utility of endomyocardial biopsy in specific clinical situations. In addition to its routine use in monitoring rejection in heart transplant recipients, endomyocardial biopsy is indicated in the evaluation of possible infiltrative cardiomyopathy, in differentiating restrictive cardiomyopathy from constrictive pericarditis, and in diagnosing and monitoring doxorubicin cardiotoxicity. The importance of diagnosing myocarditis remains controversial, and disagreement persists about the utility of immunosuppressive therapy in these patients. A combination of clinical and histologic features can divide patients with myocarditis into 4 subgroups--acute, fulminant, chronic active, and chronic persistent. This classification provides prognostic information and may identify those patients who may respond to immunosuppression, as well as those likely to have adverse outcomes from such treatment. The continued development of novel molecular techniques may allow endomyocardial biopsy to provide greater prognostic and therapeutic information in the future.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/17. Effect of vaginal delivery on the Q-Tc interval in a patient with the long Q-T (Romano-Ward) syndrome.Twelve ECG leads were monitored continuously during peripartum in a 23-year-old Japanese woman diagnosed as having the long Q-T (Romano-Ward) syndrome. Corrected Q-T (Q-Tc) intervals determined by 2 investigators blinded from the clinical informations disclosed that the Q-Tc interval increased during labor, suggesting that physical and/or emotional stress during labor might cause prolonged Q-Tc intervals in women with the long qt syndrome.- - - - - - - - - - ranking = 0.14111363542826keywords = physical (Clic here for more details about this article) |
3/17. Acute reactive hepatitis in pregnancy induced by alpha-methyldopa.BACKGROUND: Alpha-methyldopa is an antihypertensive medication used commonly in pregnancy. Reactive hepatitis is a severe, uncommon reported side effect of this medication. To our knowledge, there has been only one other reported case of alpha-methyldopa-induced hepatitis associated with pregnancy in the united states. CASE: A patient at 17 weeks' estimated gestational age was evaluated for elevated maternal serum alpha-fetoprotein, which is used generally as a screening test for birth defects. A thorough history, physical examination, and laboratory evaluation were performed, and alpha-methyldopa-induced maternal hepatitis was diagnosed. CONCLUSION: The astute clinician should include maternal hepatic dysfunction in the differential diagnosis of an elevated maternal serum alpha-fetoprotein and should consider obtaining aminotransferase levels after initiation of alpha-methyldopa therapy during pregnancy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/17. Coarctation of the descending thoracic aorta diagnosed during pregnancy.BACKGROUND:Coarctation of the aorta is an uncommon condition complicating pregnancy. It is often associated with hypertension and usually involves the aortic isthmus. CASE: Coarctation of the descending thoracic aorta was found at 21 weeks' gestation after physical findings of hypertension, a holosystolic murmur over the entire left hemithorax, and diminished lower extremity pulses. The diagnosis led to thoracotomy and placement of a graft bypass after an otherwise uneventful pregnancy. CONCLUSION: Unusual sites of coarctation of the aorta complicating pregnancy include the descending thoracic aorta.- - - - - - - - - - ranking = 0.14111363542826keywords = physical (Clic here for more details about this article) |
5/17. Circulatory congestion in obese hypertensive women: a subset of pulmonary edema in pregnancy.We describe four obese, chronically hypertensive women presenting with antepartum pulmonary edema in whom invasive hemodynamic monitoring showed elevated wedge pressure, normal to high cardiac index, and normal systemic vascular resistance. echocardiography revealed large chambers, thick walls, and increased left ventricular mass with normal systolic but abnormal diastolic function. These findings are indicative of intrinsic volume overload occurring in the presence of impaired left ventricular relaxation, a combination resulting in high filling pressures and pulmonary congestion. Diuretic therapy is indicated in this subset of patients, who could not be recognized by the usual clinical parameters such as history and physical examination, chest x-ray, and arterial blood gas.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/17. Unexpected cardiac pathology in pregnant women treated with beta-adrenergic agents (ritodrine).Premature uterine contractions were treated by intravenous beta-mimetics in 190 patients during a 2-year period. history and physical examination were directed toward identification of patients with cardiac problems. Unexpected cardiac pathology was discovered in 14 patients, all of whom exhibited severe and continuous nausea, retrosternal pain, or dyspnea during beta-mimetic administration. Treatment was immediately discontinued in the presence of S-T depression, supraventricular tachycardia, nonspecific T wave changes, and sinus tachycardia with right axis deviation. Further investigation revealed obstructive cardiac myopathy in one case and atrial septal defect in another. Such changes might be identified earlier by more extensive screening procedures (such as electrocardiogram) before drug administration. Administration of beta-mimetic agents may uncover previously unexpected cardiac pathology. Continuation of ritodrine in such cases is contraindicated and potentially hazardous.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/17. exercise-induced ventricular tachycardia.exercise tests were done on all patients referred to us because of ventricular premature beats. exercise-associated ventricular tachycardia was seen in three of these patients. Once therapy for the arrhythmia was begun in two patients, we performed serial exercise tests, attempting to provoke the arrhythmia again. In the third patients, who was pregnant, we advised against strenuous physical activity and will exercise her post partum to determine whether therapy is warranted. We have shown that exercise testing can be used successfully in unmasking ventricular arrhythmias not detectable on resting evaluation.- - - - - - - - - - ranking = 0.14111363542826keywords = physical (Clic here for more details about this article) |
8/17. warfarin embryopathy in siblings.Two siblings were noted to have the physical stigmata of the fetal warfarin syndrome. Their mother had received warfarin sodium for thrombophlebitis during both pregnancies but not during that of an unaffected sibling. teratogens may produce syndromes that mimic genetic disease in both phenotype and familial aggregation.- - - - - - - - - - ranking = 0.14111363542826keywords = physical (Clic here for more details about this article) |
9/17. Mondor disease in pregnancy.Mondor disease, or superficial thrombophlebitis of the breast, is an uncommon disorder that occurs only rarely in pregnant women. One such case is presented here followed by a review of the clinicopathologic features of the disease. Accurate diagnosis of Mondor disease is based almost entirely on careful physical examination of the breast, and no specific treatment is required. Its major clinical significance lies in the need to distinguish it from malignancy of the breast.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/17. Successful pregnancy in a woman with cyanotic congenital heart disease after a palliative pulmonary-systemic shunt. A case report.A 20-year-old woman with cyanotic congenital heart disease composed of corrected transposition of the great vessels, severe pulmonic stenosis, atresia of the left pulmonary artery and a large ventricular septal defect, had a successful pregnancy following a pulmonary-systemic shunt (Blalock-Taussig). The hemoglobin decreased from 21 to 16 g/dL following the operation. The antepartum course was complicated by intrauterine growth retardation and pregnancy-induced hypertension. A normal fetal nonstress test and biophysical profile permitted continuation of the pregnancy until 38 weeks' gestation, with delivery of a healthy infant.- - - - - - - - - - ranking = 0.14111363542826keywords = physical (Clic here for more details about this article) |
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